Clinician variation in findings of competence to stand trial.

Are some forensic evaluators more likely than others to find criminal defendants incompetent to stand trial (IST)? Although studies report aggregate IST rates of around 20% across large samples of criminal defendants, these aggregate rates tell us little about the patterns of findings among individual evaluators. This study uses 2 statewide samples to present the first available data addressing how individual clinicians vary in rates of IST opinions. Across 60 clinicians who conducted a combined total of more than 7,000 evaluations, the rates of IST findings varied considerably (range: 0% to 62%). Results suggested that some of the variability across evaluators may be attributable to the evaluator's discipline and how the evaluator considered the relationship between competence and psychosis. However, these findings raise questions about the many other evaluator, system, and policy-level characteristics that may influence evaluator variability. Thus, we suggest a research agenda that may better identify explanations for some of the variability in IST findings across evaluators. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Juvenile competence to stand trial evaluations: A survey of current practices and test usage among psychologists.

What is the current standard of practice for evaluations of juvenile competence to stand trial (JCST)? The present study surveyed psychologists regarding the practices used when conducting JCST evaluations. Respondents rated the importance of 17 elements that might be included in a JCST evaluation report. Of these elements, 7 were considered essential by 70% or more of respondents, with 9 additional elements rated as either essential or recommended. A majority of respondents felt that the use of psychological and forensic instruments was important. A list of tests used is provided, and the implications for the development of standards and policy are discussed to provide practitioners with additional knowledge that will help to further the state of the discipline. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prospects for remediating juveniles' adjudicative incompetence.

With the application of adjudicative competence requirements to adolescent defendants, there is a growing need for interventions to enhance the legal capacities of adolescents who are found to be incompetent. By reviewing developmental, clinical, and educational research, the authors discuss whether it is possible to enhance youths' legal capacities and, if so, what the most promising approaches may be. Psychoeducational interventions for youth are discussed, as well as the possibility of changing the demands of the juvenile justice system to try borderline-competent youth in juvenile court. The authors conclude that there is evidence to believe it may be challenging to enhance youths' legal capacities, particularly when youth have limited rational understanding and/or legal reasoning capacities, and when these deficits stem from developmental immaturity and/or mental retardation. A research agenda is proposed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adjudicative competence in adolescent defendants: Judges' and defense attorneys' views of legal standards for adolescents in juvenile and criminal court.

Although courts have increasingly required that adolescent defendants be competent to proceed with adjudication, the legal standard for competence in juvenile court is not yet settled. As a first step toward obtaining greater clarification in legal standards, in this study the authors surveyed 338 judges and defense attorneys regarding their beliefs about competence standards. Judges and defense attorneys believe that it is particularly important for juveniles to have competence-related legal capacities, compared to adults. However, lower levels of competence were considered necessary for juveniles adjudicated in juvenile court than for juveniles adjudicated in criminal court. Developmental immaturity was seen as moderately important to juveniles' competence, although it was rated as less important than mental disorders or cognitive impairments. Furthermore, relatively few judges appear to agree that adolescents should be found incompetent on the basis of developmental immaturity alone. The implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceived discrimination and health: A meta-analytic review.

Perceived discrimination has been studied with regard to its impact on several types of health effects. This meta-analysis provides a comprehensive account of the relationships between multiple forms of perceived discrimination and both mental and physical health outcomes. In addition, this meta-analysis examines potential mechanisms by which perceiving discrimination may affect health, including through psychological and physiological stress responses and health behaviors. Analysis of 134 samples suggests that when weighting each study’s contribution by sample size, perceived discrimination has a significant negative effect on both mental and physical health. Perceived discrimination also produces significantly heightened stress responses and is related to participation in unhealthy and nonparticipation in healthy behaviors. These findings suggest potential pathways linking perceived discrimination to negative health outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Searching for Uniformity in Adjudications of the Accused's Competence to Assist and Consult in Capital Cases.

Based on the review of capital cases from various jurisdictions involving issues of competence to stand trial, this article examines the standards, literature, and varying practices associated with competence assessments and adjudications. The author, who is an experienced criminal defense lawyer with capital trial and postconviction litigation experience, examines the implications of disparities in the approaches and definitions used in dealing with competence assessments and suggests solutions to improve the standards of practice related to these important assessments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist adherence/competence and treatment outcome: A meta-analytic review.

Objective: The authors conducted a meta-analytic review of adherence–outcome and competence–outcome findings, and examined plausible moderators of these relations. Method: A computerized search of the PsycINFO database was conducted. In addition, the reference sections of all obtained studies were examined for any additional relevant articles or review chapters. The literature search identified 36 studies that met the inclusion criteria. Results: R-type effect size estimates were derived from 32 adherence–outcome and 17 competence–outcome findings. Neither the mean weighted adherence–outcome (r = .02) nor competence–outcome (r = .07) effect size estimates were found to be significantly different from zero. Significant heterogeneity was observed across both the adherence–outcome and competence–outcome effect size estimates, suggesting that the individual studies were not all drawn from the same population. Moderator analyses revealed that larger competence–outcome effect size estimates were associated with studies that either targeted depression or did not control for the influence of the therapeutic alliance. Conclusions: One explanation for these results is that, among the treatment modalities represented in this review, therapist adherence and competence play little role in determining symptom change. However, given the significant heterogeneity observed across findings, mean effect sizes must be interpreted with caution. Factors that may account for the nonsignificant adherence–outcome and competence–outcome findings reported within many of the studies reviewed are addressed. Finally, the implication of these results and directions for future process research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Competency to Stand Trial.

Reviews the book, Competency to Stand Trial by Ronald Roesch and Stephen Golding (1981). Competency to Stand Trial is about the kinds of tests used by psychiatrists and other clinicians in the course of Court-ordered evaluations. The book does in fact though deal with a set of issues probably even more important than assessing insanity (as under Section 16 of the Criminal Code of Canada). Roesch and Golding examined the way in which competency, or fitness, examinations were conducted in North Carolina. Their research was set in motion when they were asked to advise on the building of new facilities for the conduct of fitness examinations. Competency to Stand Trial shows how, with careful thought and analysis, behavioural scientists can sometimes transform the nature of a problem quite fundamentally. Roesch and Golding have written an admirable book. It contains an excellent and readable summary of the legal issues around competency, impeccable data with well reasoned argument, and thoughtful, challenging suggestions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factor structure and validity of the MacArthur Competence Assessment Tool--Criminal Adjudication.

Examination of the available literature regarding the development of the MacArthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA) reveals 2 theoretical factor structures on which the MacCAT-CA was based: one in which 3 lower-order constructs are proposed (understanding, reasoning, appreciation) and one in which 2 higher-order constructs are proposed (competence to assist counsel and decisional competence). Confirmatory factor analyses were conducted with the MacCAT-CA's original normative sample (N = 729) to test both the relative fit of these 2 theoretical factor structures and models that combine the 2 factor structures. Analyses were also completed to examine the convergent and discriminant validity of the MacCAT-CA. Results are discussed in terms of the strengths and weaknesses of the nomothetic nature of the MacCAT-CA. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An Examination of the ECST-R as a Screen for Feigned Incompetency to Stand Trial.

Psychological assessments of competency-to-stand-trial (CST) referrals must consider whether the defendants' impairment is genuine or feigned. This study addressed feigning on the Evaluation of Competency to Stand Trial--Revised (ECST-R), a standardized interview designed for assessing dimensions of CST and screening for feigned CST. In particular, this study examined the effectiveness of the ECST-R's Atypical Presentation (ATP) scales as screens for feigned incompetency. It examined ATP scales for (a) jail detainees (n=96) in simulation and control conditions and (b) inpatient competency cases (n=56) in clinical comparison and probable malingering groups. Comparisons of ATP scales yielded very large effect sizes for feigners when compared with jail controls (mean d=2.50) and genuine inpatient competency cases (mean d=1.83). Several cut scores were established with very few false negatives and robust sensitivity estimates. In summary, the ECST-R ATP scales appear to be homogenous scales with established clinical use as feigning screens in CST evaluations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A meta-analytic examination of hardiness.

Hardiness, which is a multidimensional personality trait that is hypothesized to protect people from the effects of stress, has attracted considerable research attention during the last 30 years. The current study provides a meta-analytic review of hardiness. Specifically, we examined the relationships between the hardiness facets, the relationship between hardiness and other personality variables, as well as the relationships between hardiness and several hypothesized criteria, including stressors, strains, social support, coping, and performance. Our analyses generally suggest that hardiness is: (a) positively related to other personality traits that are expected to protect people from stress, (b) negatively related to personality traits that are expected to exacerbate the effects of stress, (c) negatively related to stressors, strains, and regressive coping, and (d) positively related to social support, active coping, and performance. Regression analyses suggest that hardiness is significantly related to important criteria after the effects of other personality traits (e.g., the Five Factor Model traits) are controlled. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Application of the competency model to clinical health psychology.

In response to the growing emphasis on defining professional competence within applied psychology (e.g., clinical, neuropsychology, counseling, school), in 2007 American Psychological Association Division 38 (Health Psychology) sponsored a summit meeting with a specific focus on revisiting the standards of graduate curricula and training in clinical health psychology. Using the cube model of core competency domains of professional psychology as a framework, summit participants were charged with identifying the foundational and functional competencies expected of a well-trained, entry-level clinical health psychologist. As a product of these discussions, the present article is presented as an initial effort to identify the competencies and begin the discussion in clinical health psychology. As such it is likely to be of interest to a wide audience, including clinical training programs with an existing or planned emphasis in clinical health psychology, practitioners interested in acquiring the competencies required to practice as a clinical health psychologist, and students evaluating potential graduate and postgraduate training options in clinical health psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prominent consequences of role stress: A meta-analytic review.

Role stress has received a lot of research attention in psychological, sociological, and organizational studies over the last several decades. Based on a literature review of about 300 journal articles, this article examines prominent consequences of role stress. Specific focus is on researching differences in relationships between facets of role stress (i.e., role ambiguity, role conflict, and role overload) and frequently cited consequences using techniques of meta-analysis. Findings indicate that each role stress facet has a different relationship with the eight consequences studied. Role stress research can benefit from looking at each facet individually in addition to role stress generally. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neurocognition in first-episode schizophrenia: A meta-analytic review.

Compromised neurocognition is a core feature of schizophrenia. Following Heinrichs and Zakzanis’s (1998) seminal meta-analysis of middle-aged and predominantly chronic schizophrenia samples, the aim of this study is to provide a meta-analysis of neurocognitive findings from 47 studies of first-episode (FE) schizophrenia published through October 2007. The meta-analysis uses 43 separate samples of 2,204 FE patients with a mean age of 25.5 and 2,775 largely age- and gender-matched control participants. FE samples demonstrated medium-to-large impairments across 10 neurocognitive domains (mean effect sizes from ?0.64 to ?1.20). Findings indicate that impairments are reliably and broadly present by the FE, approach or match the degree of deficit shown in well-established illness, and are maximal in immediate verbal memory and processing speed. Larger IQ impairments in the FE compared to the premorbid period, but comparable to later phases of illness suggests deterioration between premorbid and FE phases followed by deficit stability at the group level. Considerable heterogeneity of effect sizes across studies, however, underscores variability in manifestations of the illness and a need for improved reporting of sample characteristics to support moderator variable analyses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Justice at the millennium: A meta-analytic review of 25 years of organizational justice research.

The field of organizational justice continues to he marked by several important research questions, including the size of relationships among justice dimensions, the relative importance of different justice criteria, and the unique effects of justice dimensions on key outcomes. To address such questions, the authors conducted a meta-analytic review of 183 justice studies. The results suggest that although different justice dimensions are moderately to highly related, they contribute incremental variance explained in fairness perceptions. The results also illustrate the overall and unique relationships among distributive, procedural, interpersonal, and informational justice and several organizational outcomes (e.g., job satisfaction, organizational commitment, evaluation of authority, organizational citizenship behavior, withdrawal, performance). These findings are reviewed in terms of their implications for future research on organizational justice. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Does incubation enhance problem solving? A meta-analytic review.

A meta-analytic review of empirical studies that have investigated incubation effects on problem solving is reported. Although some researchers have reported increased solution rates after an incubation period (i.e., a period of time in which a problem is set aside prior to further attempts to solve), others have failed to find effects. The analysis examined the contributions of moderators such as problem type, presence of solution-relevant or misleading cues, and lengths of preparation and incubation periods to incubation effect sizes. The authors identified a positive incubation effect, with divergent thinking tasks benefiting more than linguistic and visual insight tasks from incubation. Longer preparation periods gave a greater incubation effect, whereas filling an incubation period with high cognitive demand tasks gave a smaller incubation effect. Surprisingly, low cognitive demand tasks yielded a stronger incubation effect than did rest during an incubation period when solving linguistic insight problems. The existence of multiple types of incubation effect provides evidence for differential invocation of knowledge-based vs. strategic solution processes across different classes of problem, and it suggests that the conditions under which incubation can be used as a practical technique for enhancing problem solving must be designed with care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Challenges to the assessment of competence and competencies.

Challenges to the assessment of competence and competencies in professional psychology are discussed in this article. These include difficulties in defining competencies in precise and measurable terms; reaching agreement within the profession about the key elements of each competence domain; establishing an armamentarium of tools for assessing all components of competence, including the knowledge base, skills, and attitudes (and their integration); determining appropriate agreed-upon minimal levels of competence for individuals at different levels of professional development and when "competence problems" exist for individuals; assuring the fidelity of competency assessments; and establishing mechanisms for providing effective evaluative feedback and remediation. But even if these challenges can be met, perhaps the single biggest obstacle would be convincing those who are skeptical of the value of the culture shift toward the implementation of comprehensive competence assessments across the professional life span. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Culturally adapted mental health intervention: A meta-analytic review.

There is a pressing need to enhance the availability and quality of mental health services provided to persons from historically disadvantaged racial and ethnic groups. Many previous authors have advocated that traditional mental health treatments be modified to better match clients' cultural contexts. Numerous studies evaluating culturally adapted interventions have appeared, and the present study used meta-analytic methodology to summarize these data. Across 76 studies the resulting random effects weighted average effect size was d = .45, indicating a moderately strong benefit of culturally adapted interventions. Interventions targeted to a specific cultural group were four times more effective than interventions provided to groups consisting of clients from a variety of cultural backgrounds. Interventions conducted in clients' native language (if other than English) were twice as effective as interventions conducted in English. Recommendations are provided for improving the study of outcomes associated with mental health interventions adapted to the cultural context of the client. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Motivational interviewing for smoking cessation: A meta-analytic review.

Objective: Motivational interviewing (MI) is a treatment approach that has been widely examined as an intervention for tobacco dependence and is recommended in clinical practice guidelines. Previous reviews evaluating the efficacy of MI for smoking cessation noted effects that were modest in magnitude but included few studies. The current study is a comprehensive meta-analysis of MI for smoking cessation. Method: The meta-analysis included 31 controlled trials with an abstinence outcome variable. Studies with nonpregnant (N = 23) and pregnant samples (N = 8) were analyzed separately. Results: For nonpregnant samples, combined results suggest that MI significantly outperformed comparison conditions at long-term follow-up points (dc = .17). The magnitudes of this result represented a 2.3% difference in abstinence rates between MI and comparison groups. All analyses investigating the impact of moderating participant, intervention, and study design characteristics on outcome were nonsignificant, with the exception of studies including international, non-U.S. samples, which had larger effects overall. Several subgroups of studies had significant combined effect sizes, pointing to potentially promising applications of MI, including studies that had participants with young age, medical comorbidities, low tobacco dependence, and, consistent with clinical practice guidelines, low motivation or intent to quit. Effects were smaller among pregnant samples. In addition, significant combined effect sizes were observed among subgroups of studies that administered less than 1 hr of MI and among studies that reported high levels of treatment fidelity. Conclusions: The results are interpreted in light of other behavioral approaches to smoking cessation, and the public health implications of the findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sex differences in cooperation: A meta-analytic review of social dilemmas.

Although it is commonly believed that women are kinder and more cooperative than men, there is conflicting evidence for this assertion. Current theories of sex differences in social behavior suggest that it may be useful to examine in what situations men and women are likely to differ in cooperation. Here, we derive predictions from both sociocultural and evolutionary perspectives on context-specific sex differences in cooperation, and we conduct a unique meta-analytic study of 272 effect sizes—sampled across 50 years of research—on social dilemmas to examine several potential moderators. The overall average effect size is not statistically different from zero (d = –0.05), suggesting that men and women do not differ in their overall amounts of cooperation. However, the association between sex and cooperation is moderated by several key features of the social context: Male–male interactions are more cooperative than female–female interactions (d = 0.16), yet women cooperate more than men in mixed-sex interactions (d = –0.22). In repeated interactions, men are more cooperative than women. Women were more cooperative than men in larger groups and in more recent studies, but these differences disappeared after statistically controlling for several study characteristics. We discuss these results in the context of both sociocultural and evolutionary theories of sex differences, stress the need for an integrated biosocial approach, and outline directions for future research. (PsycINFO Database Record (c) 2011 APA, all rights reserved)